The benefits of engaging in moderate-to-vigorous physical activity have been documented in the literature. The neighbourhood environment, which could influence large proportions of population for sustained periods of time, has been associated with physical activity in Western countries. Yet, it remains unclear that how the neighbourhood environment in ultra-dense Hong Kong, especially with respect to proximity and availability of recreational facilities, is associated with physical activity of its residents. This study examines the associations between neighbourhood recreational facility, in both perceived and objective measures, and physical activity of residents in Hong Kong. The differences between perceived and objective availability of recreational facilities, and the perceived encouraging or discouraging features of a self-reported recreational facility were also examined. The availability of recreational facilities between high and low socio-economic status neighbourhoods was compared to identify inequalities of recreational resource allocation. A total of 480 participants aged 18-65 years, living in 32 neighbourhoods of different extremes of walkability and socio-economic status, were recruited to complete an interviewer-administered questionnaire in which the perceived aspects of neighbourhood recreational facilities were examined, and to wear a motion sensor which objectively measure physical activity for 7 consecutive days. Objective availability of 14 types of recreational facilities, categorized into combinations of indoor or outdoor and public, residential or commercial facilities, were quantified by direct observations. Geographical Information Systems further provided objective data regarding the number of parks, sports centres, sports grounds, playgrounds, swimming pools, bike lanes and pavilions available in the examined neighbourhoods. The objectively-assessed numbers of residential outdoor table tennis courts and public indoor swimming pools, and the presence of tennis courts, pavilions and swimming pools, as well as the perceived presence of bike lanes and swimming pools were positively associated with moderate-to-vigorous physical activity. In contrast, the objectively-assessed numbers of playgrounds, and the presence of soccer pitches, squash courts and playgrounds, were negatively associated with moderate-to-vigorous physical activity. Poor agreements between perceived and objective availability of volleyball courts, soccer pitches, walking trails, weight and cardio-training equipment were observed. In contrast, good agreement between perceived and objective availability of tennis courts was observed. The level of agreement between perceived and objective availability of specific types of recreational facilities was influenced by the types of neighbourhood where participants lived and socio-demographics characteristics, such as age, education level and monthly household income. Perceived encouraging and discouraging features of a regularly-used recreational facility were observed across different domains, including the conditions of changing rooms and toilets, environmental safety, and aesthetics. High socio-economic status neighbourhoods had higher numbers of pavilions and swimming pools, and had higher odds of having sports grounds, swimming pools and tennis courts than low socio-economic status neighbourhoods. The findings of this study imply that certain types of recreational facilities have the potential to promote physical activity. Public health policy makers should enhance public awareness of neighbourhood recreational facilities, improve their quality and equality in distribution among high and low socio-economic status neighbourhoods, in an attempt to promote physical activity. / published_or_final_version / Human Performance / Doctoral / Doctor of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Sports Science / Master / Master of Science in Sports Science

published_or_final_version / Community Medicine / Master / Master of Philosophy

本論文之研究目的為：一，發展適用於香港兒童之體力活動相關社區環境調查問卷；二，以此問卷作為測量工具之一，研究社區環境與香港兒童體力活動之關係。本論文之研究共分三個部份。 / 研究一(第2章)選取居住於不同社會經濟地位和住宅密度的四類社區的34名10-11歲香港兒童，採用名義群組法（Nominal Group Technique, NGT)調查了他們認為會影響其參加體力活動的社區環境因素。參試兒童針對問題“有哪些社區環境因素會增加或減少你參與體力活動的意願？提出自己的觀點，並依據其重要性進行排序。共計十六項被參試兒童認為重要的環境因素被最終確定。其中，“充足的照明、“天橋或隧道、“馬路上車較少、“方便的交通、“地鐵站、“康樂場所、“有空調的商場、“空氣新鮮、“有趣的動物和“香水店被認為會增加做體力活動的意願。而“讓我覺得不安全的人、“附近有罪案發生、“夜晚害怕被帶走或傷害、“商場中很難找到廁所、“很多噪音和“康樂場所內人太多被認為會減少做體力活動的意願。上述與體力活動有關的環境因素貼合香港之環境及兒童之年齡。本研究之結果可被用於發展或補充適用於香港兒童的社區環境調查問卷。 / 研究二（第3章）發展了適用於香港兒童的全面的社區環境調查問卷，即兒童體力活動相關社區環境調查問卷（The Neighborhood Environment Walkability Scale forChinese Children, NEWS-CC ) ° 該問卷改編自其英文版（ T h e Neighborhood Environment Walkability Scale for Youth, NEWS-Y)，並加入了研究一所確定的部f分環境因素。該問卷之重測信度（test-retest reliability)及因素效度（factorial validity)分別以組內相關係數（intraclass correlation coefficients, ICCs)及驗證性因素分析 (confirmatory factor analysis)檢測。樣本為來自香港七所小學的953名4-6年級學生。最終的NEWS-CC問卷由67個題目構成，測量10個方面的社區環境，即土地利用多樣性、交通安全、治安安全、美觀性、行人設施、街道連接性、土地利用通達性、居住密度、康樂場地和污染。結果題示NEWS-CC問卷具有良好的因素效度(滿足模型吻合度標準）和重測信度（分量表之ICCs=0.47-0.86)。 / 研究三（第4章）以1279名來自九所香港小學的4-6年級的學生為樣本，研究了以主觀及客觀方法測量的社區環境與兒童體力活動的關係。社區環境分別以NEWS-CC 問卷及地理信息系統（Geographic Information Systems, GIS)測量 ° 兒童總體體力活動及校外體力活動以自我報告法測量。此外，加速度計被應用於其中361 名兒童測量其在返學日（weekday overall MVPA )、返學日校外時段 weekday non-school MVPA)及週末日的中高強度體力活動（weekend overall MVPA)。環境因 素與兒童體力活動之關係以線性混合模型（linear mixed models)分析，同時控制社會人口統計指標。結果發現，環境美觀性與男生報告的總體及校外體力活動正相關；距離康樂場地較近或距離返學之學校較遠的男生加速度計測量的返學日及返學日校外體力活動均較高，而感知的行人設施與男生加速度計測量的週末日體力活動負相關。對女生而言，距離公園/花園較近及居住在較高收入社區者自我報告的校外體力活動較高；距離康樂場地的距離與女生加速度計測量的返學日體力活動負相關；而距離返學學校的距離、距離公園/花園的距離分別與加速度計測量的返學日校外體力活動和週末體力活動正相關。 / 綜上所述，本論文的研究發展了適用於香港兒童的全面的社區環境調查問卷，並且發現了一些與兒童體力活動相關的環境因素，包括環境美觀性、感知的行人設施、距公園/花園距離、距康樂場地距離、距返學學校距離以及社區家庭收入。上述環境因素與兒童體力活動的關係因體力活動的發生場景、體力活動的測量方式及兒童性別而不同。本論文的發現將有助於今後發展以研究場景及性別特異性的兒童體力活動環境相關因素為目標的追蹤及干預研究。 / The purposes of this thesis were to, first, develop a useful instrument for measurement of perceived neighborhood environment in Hong Kong children, and second, to examine the relationship between the neighborhood built environment and physical activity (PA) behaviors of children in Hong Kong. Three stepwise studies were conducted to address these purposes. / In the first study (Chapter 2), five nominal group technique (NGT) groups were conducted among 34 children aged 10-11 years from four types of neighborhoods varying in socio-economic status and household density in Hong Kong. In each NGT group, environmental items were generated by children in response to the question "What neighborhood environment do you think would increase or decrease your willingness to do PA?’’ Items were prioritized based on the number of votes that they received from children, which served as an indicator of their importance to PA. Sixteen unique environmental items, which were perceived by children as the most important factors influencing their PA, were identified. Items perceived as facilitators of children's PA included "Sufficient lighting"，“Bridge or tunnel"，“Few cars on roads"，“Convenient transportation"，"Subway station"，“Recreation grounds"，“Shopping malls with air conditioning"，"Fresh air"，“Interesting animals"，and “Perfume shop". Conversely, items perceived as barriers included “People who make me feel unsafe"，“Crimes nearby"，“Afraid of being taken or hurt at night’’，"Hard to find toilet in shopping mall", “Too much noise"，and “Too many people in recreation grounds". These PA-related environmental attributes were believed to be relevant to both the Hong Kong context and the children. The findings of this study could be used to develop or complement instruments that measure children's perceived neighborhood environment in Hong Kong. / The second study (Chapter 3) developed a comprehensive questionnaire assessing perceived neighborhood environment for Chinese children in Hong Kong, namely, the Neighborhood Environment Walkability Scale for Chinese Children (NEWS-CC). The development of the NEWS-CC was based on the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) with incorporation of selected items identified in the first study. The test-retest reliability and factorial validity of the NEWS-CC were examined by intraclass correlation coefficients (ICCs) and confirmatory factor analysis, respectively, in a sample of 953 children in the 4th to 6th grades from seven local primary schools. The final NEWS-CC consists of 67 items, which measure 10 aspects of the perceived neighborhood environment including land use mix-diversity, traffic safety, crime safety, aesthetics, walking facilities, street connectivity, land use mix-access, residential density, recreation facilities, and pollution. The results indicated that the NEWS-CC possesses adequate factorial validity according to the recommended criteria of model fit and acceptable test-retest reliability with ICCs of subscales ranging from 0.47 to 0.86. / The third study (Chapter 4) examined how perceived and objective neighborhood environment were related to children's PA behaviors among 1279 children in the 4th to 6th grades from nine local primary schools. The neighborhood built environment was measured by the NEWS-CC questionnaire and the geographic information systems (GIS). The children's overall and non-school PA were assessed by self-report. In addition to the self-report measure of PA, the accelerometry was used in a sub-sample of 361 children to objectively measure their moderate-to-vigorous PA (MVPA) during weekdays (weekday overall MVPA), non-school periods on weekdays (weekday non-school MVPA), and weekend days (weekend overall MVPA). A series of linear mixed models were performed to determine the associations between environmental factors and children's PA, with adjustments for certain sociodemographic factors. For the self-reported PA of boys, perceived aesthetics was positively related to overall and non-school PA. For the objective PA of boys, shorter distance to nearest recreation ground and longer distance to attended school were related to more weekday overall MVPA and more weekday non-school MVPA; meanwhile, perceived walking facilities was negatively related to weekend overall MVPA. For the self-reported PA of girls, shorter distance to nearest park/garden and living in neighborhoods with higher household income were related to increased non-school PA. For the objective PA of girls, distance to nearest recreation ground was negatively associated with weekday overall MVPA; by contrast, distance to attended school had a positive association with weekday non-school MVPA, and distance to nearest park/garden was positively related to weekend overall MVPA. / In conclusion, the studies in this thesis have developed a useful instrument that provides comprehensive measures of perceived neighborhood environment for children in Hong Kong. Moreover, certain environmental correlates of PA have been identified for Hong Kong children, including perceived aesthetics, perceived walking facilities, distance to nearest park/garden, distance to nearest recreation ground, distance to attended school, and neighborhood household income. Such environmental correlates were shown to relate differentially to children's PA, based on activity context, activity measurement mode, and gender The findings in this thesis would inform future longitudinal and intervention studies by targeting the context- and gender-specific environmental correlates of children's PA. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / He, Gang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 148-172). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese. / ABSTRACT --- p.i / ACKNOWLEGEMENTS --- p.vi / PUBLICATIONS --- p.vii / CONTENTS --- p.viii / LIST OF TABLES --- p.xi / LIST OF FIGURES --- p.xiii / ABBREVIATIONS --- p.xiv / Chapter CHAPTER 1 --- Introduction --- p.1 / Chapter 1.1 --- PA and health in children --- p.3 / Chapter 1.2 --- PA levels of children --- p.8 / Chapter 1.3 --- Neighborhood built environment and children's PA --- p.11 / Chapter 1.3.1 --- Measures of the built environment in large-scale studies --- p.13 / Chapter 1.3.1.1 --- GIS-based measures of the built environment --- p.15 / Chapter 1.3.1.1.1 --- Data sources --- p.15 / Chapter 1.3.1.1.2 --- Key terminology --- p.17 / Chapter 1.3.1.1.3 --- GIS-based measures --- p.19 / Chapter 1.3.1.2 --- Perceived measures of the built environment --- p.25 / Chapter 1.3.2 --- Neighborhood environmental correlates of children's PA --- p.33 / Chapter 1.3.2.1 --- Neighborhood built environment and children's overall PA --- p.33 / Chapter 1.3.2.2 --- Neighborhood built environment and children's active travel --- p.35 / Chapter 1.3.2.3 --- Neighborhood built environment and children's location- or time-specific PA --- p.36 / Chapter 1.3.2.4 --- Studies examining neighborhood environmental correlates of children's PA in Hong Kong --- p.40 / Chapter 1.4 --- Summary --- p.42 / Chapter CHAPTER 2 --- Neighborhood Environment Attributes Related to Hong Kong Children's Physical Activity Determined by Nominal Group Technique --- p.45 / Chapter 2.1 --- Introduction --- p.45 / Chapter 2.2 --- Methods --- p.47 / Chapter 2.2.1 --- Participants --- p.47 / Chapter 2.2.2 --- Procedure --- p.49 / Chapter 2.3 --- Results --- p.52 / Chapter 2.3.1 --- Characteristics of NGT groups --- p.52 / Chapter 2.3.2 --- PA-related neighborhood environmental factors identified by NGT --- p.groups..…53 / Chapter 2.4 --- Discussion --- p.57 / Chapter 2.5 --- Conclusion --- p.64 / Chapter CHAPTER 3 --- Reliability and Validity of the Neighborhood Environment Walkability Scale for Chinese Children (NEWS-CC) --- p.65 / Chapter 3.1 --- Introduction --- p.65 / Chapter 3.2 --- Methods --- p.68 / Chapter 3.2.1 --- Measures --- p.68 / Chapter 3.2.2 --- Participants and procedures --- p.69 / Chapter 3.2.2.1 --- Translation of the NEWS-Y --- p.69 / Chapter 3.2.2.2 --- Identification of environmental items specific for Hong Kong children. --- p.72 / Chapter 3.2.2.3 --- Pilot testing of the NEWS-CC --- p.73 / Chapter 3.2.2.4 --- Reliability and factorial validity testing of the NEWS-CC --- p.74 / Chapter 3.2.3 --- Data analysis --- p.75 / Chapter 3.2.3.1 --- Confirmatory factor analysis of the original NEWS-CC --- p.75 / Chapter 3.2.3.2 --- Test-retest reliability of the respecified NEWS-CC --- p.76 / Chapter 3.2.3.3 --- Re-working of unreliable items/subscales in the respecified NEWS-CC --- p.76 / Chapter 3.3 --- Results --- p.77 / Chapter 3.3.1 --- Confirmatory factor analysis of the original NEWS-CC --- p.77 / Chapter 3.3.2 --- Test-retest reliability of the respecified NEWS-CC --- p.79 / Chapter 3.3.3 --- Re-working of unreliable items/subscales in the respecified NEWS-CC --- p.82 / Chapter 3.3.4 --- Confirmatory factor analysis of the final NEWS-CC --- p.84 / Chapter 3.4 --- Discussion --- p.86 / Chapter 3.4.1 --- Development of the NEWS-CC --- p.86 / Chapter 3.4.2 --- Factorial validity of the NEWS-CC --- p.87 / Chapter 3.4.2.1 --- Factorial structure of the NEWS-CC --- p.88 / Chapter 3.4.2.2 --- Items excluded from the NEWS-CC --- p.89 / Chapter 3.4.3 --- Test-retest reliability of the NEWS-CC --- p.92 / Chapter 3.5 --- Conclusion --- p.95 / Chapter CHAPTER 4 --- Neighborhood Built Environment and Physical Activity in Primary Schoolchildren in Hong Kong --- p.96 / Chapter 4.1 --- Introduction --- p.96 / Chapter 4.2 --- Methods --- p.99 / Chapter 4.2.1 --- Participants --- p.99 / Chapter 4.2.2 --- Measurements --- p.100 / Chapter 4.2.2.1 --- Dependent variables --- p.100 / Chapter 4.2.2.2 --- Environmental variables --- p.101 / Chapter 4.2.2.3 --- Sociodemographic variables --- p.104 / Chapter 4.2.3 --- Data analysis --- p.105 / Chapter 4.3 --- Results --- p.107 / Chapter 4.3.1 --- Descriptive statistics --- p.107 / Chapter 4.3.2 --- Bivariate correlations between PA variables and independent variables --- p.109 / Chapter 4.3.3 --- Association between environmental variables and PA behaviors --- p.117 / Chapter 4.3.3.1 --- Association between environmental variables and PA behaviors in boys --- p.117 / Chapter 4.3.3.2 --- Association between environmental variables and PA behaviors in girls --- p.120 / Chapter 4.4 --- Discussion --- p.123 / Chapter 4.4.1 --- Characteristics of children's PA --- p.123 / Chapter 4.4.2 --- Patterns of PA-environment associations between children's overall and non-school PA --- p.124 / Chapter 4.4.3 --- Environmental correlates of children's PA in Hong Kong --- p.126 / Chapter 4.5 --- Conclusion --- p.134 / Chapter CHAPTER 5 --- Summary and Conclusions --- p.135 / Chapter 5.1 --- Measures of perceived neighborhood built environment --- p.137 / Chapter 5.2 --- Neighborhood environmental correlates of children's PA behaviors --- p.142 / REFERENCES --- p.148 / APPENDICES --- p.A1 / Chapter Appendix A --- Letter to Principal --- p.A1 / Chapter Appendix B --- Consent Form --- p.A3 / Chapter Appendix C --- 兒童體力活動相關社區環境調查問卷 --- p.A5 / Chapter Appendix D --- The Neighborhood Environment Walkability Scale for Chinese Children / (NEWS-CC) --- p.A14

published_or_final_version / Education / Master / Master of Education